The value of serum γ-G. T. P. in diagnosing the degree of obstruction in biliary diseases is studied.
Serum γ-G. T. P. activity was measured in 59 patients with biliary diseases. (Table 1) The site of obstruction was confirmed by the operation in 45 patients. Serum γ-G. T. P. was measured according to the modified Orlowski' s method using the γ-G. T, P. Kit (CS-346) by the SANKYO PRODUCTS. The mean value of in normal human subjects is 13.6±11.6 mu/ml.
When the stones are located in the gall bladder, common bile duct and sphincter of Oddi, the mean value of γ-G. T. P. is 104.1±122.1, 359.8±260.0 and 862.4±663.6 mu/ml respectively. Maximum level of serum γ-G. T. P. was found in patients with stones impacted at the sphincter of Oddi. The serum level of γ-G. T. P. is correlated with extrahepatic cholestasis. The degree of abnormalization is considered as index of extrahepatic obstruction.
The correlation of level of γ-G. T. P. with L. A. P. is higher than that with Al. Pase…(Table 3, 4) Elevated γ-G. T. P. cases with normal level of L. A. P. and Al. Pase. were found. In cases having impacted stones, level of γ-G. T. P. showed more than 20 times of the normal value, though Al. Pase. revealed 3 times and L. A. P. 2 times. All the cases but two returned to normal value after the relief of obstruction by surgery. The two cases showed elevated γ-G. T. P. than previous level. The wedge liver biopsy was performed in all cases. The above described two cases revealed the liver cirrhosis and cholestatic hepatitis respectively. From these findings serum γ-G. T. P. appears to reveal earlier stage of the liver damadge of which conventional liver function tests could not be detectable as yet.

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In 1969, Zaltkis and Zak reported that O-phthalaldehyde was available for the determination based on their report and revealed that the method was less interfered by Bilirubin and other substances.
Author have attempted to evaluate this method and study on the reason of the difference among o-PA method and Zak-Henly modification method.
This is the report of my study.
o-PA method
As the result of my experiments, I found this method was not interfered by Bilirubin and light. I also found that the accuracy and the reproducibility of this method was satisfactory to use as the direct micro determination of cholesterol. Therefore, I consider that the o-PA method is one of the most satisfactory one at present and pays a role of the rationalization of the cholesterol determination.
Difference between the value of the o-PA method and that of Zak-Henly modification method.
1. From the regression study, the o-PA method give the 7% higher value than that of Zak-Henly modification method.
2. Ferric chloride-sulfuric acid reaction is obviously affected by the concentration of FeCl³·6H²O.
3. Although the concentration of Ferric chloride in the reaction mixture of standard of the Zak-Henly modification method is 75 mg/dl, the concentration in the reaction mixture of deproteinized solution from serum sample is 57 mg/dl. Resultantly, the value of the Zak-Henly modification method is calculated lower than the true value.
4. It is preferable to use 57 mg/dl of Ferric chloride-acetic acid solution for the standard reaction mixture.
5. Correlation between the residual concentration of Ferric chloride in deproteinized solution and the protein concentration of the sample shows not a negative regression line but negative regression curve.
Finally, I concluded that the difference between o-PA method and the Zak-Henly nodification method depends on the inadequate treatment of the satandard with Zak-Henly modification method.

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FLUPENTIXOL* was administered to twenty-one patients with chronic schizophrenia having symptoms such as decreased expression, apathy, hypobulia and disturbance of rapport which had caused obstacle to their rehabilitation.
The drug was given orally at daily doses between 3 and 9 mg for 5 to 210 days, The cumulative dosage ranged from 15 to 1, 170 mg per patient. Anti-parkinsonian agents were given concomitantly with flupentixol in all cases, and other psychotropic drugs in most cases.
During the medication, the schizophrenic symptoms were well improved in 4 cases, moderately improved in 3, temporary improved in $, unchanged in 3 and worsend in 3 cases. Namely, 71% of patients improved with flupentixol.
The drug showed effect in 71% of patients with affectional disturbances such as decreased expression, apathy and disturbance of rapport, and it showed effect in 52% of patients with volitional disturbances such as abulia, bedfast life and decreased spontaneity. However, the effect was not definite in patients with abnormal experiences such as hallucination and delusion. It exerted little sedative effect to excitation of patients.
As to the side effects, sleep disturbance was observed in 33% of patients treated, , so-called restless akathisia of Divry in 33%, burst of psychic symptoms such as hallucination, delusion and manic state in 33%, and increased libido in 19%. Hypotension, Parkinson's syndrome, dullness, nausea and anorexia were also observed. All these side effects were disappeared or decreased by symptomatic treatment or discontinuation of the medication.
In conclusion, flupentixol is effective against the fundamental symptoms of schizophrenia such as decreased expression, apathy, hypobulia and disturbance of rapport. It is especially usefull for the treatment of schizophrenic patients with affectional disturbances.
*2-trifluoromethyl-9{3-[4-(2-hydroxyethyl)-piperazin-1-yl]propylidene}thioxanthene dihydro-chloride

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In order to know the facts and trends on “active infectious tuberculosis patients” in homes, compared to be investigated 5 years ago, about 20% of all patients through 44 public health centers of the Tohoku District were surveyed and the following conclusions were obtained.
Among the 662 investigated patients, men occupied a large majority. Among the all patients, the aged over 60 years old and the patients with the lapse of longer years after the detection of their sickness were more than 5 years ago. The positive bacilli patients occupied 13.6% and the negative 55.1%. Among the patients whose sputa were examined, 19.9% were positive for bacilli, and this is about a half of the ratio what was investigated before.
Compared to other professions, bacilli positive patients were not numerous among merchants. Bacilli positive patients were found more in the house-wives than in others.
The patients who had been in the hospital occupied 67.7% and were more than before. The patients who had been in the hospital more than one year and who had been under continuous outpatients treatment were more than 5 years ago.
The 55.2% of the patients had been working, and this ratio is less than what was investigated before. The 16.2% of these patients whose sputa was examined showed positive bacilli.
The reason why the patients were not in the hospital were as follows: ‘doctor's order’ 48.5%, ‘house-hold economy’, no subjective symptom and others less than before. The doctor's advice for hospitalization were almost adequate.
The 11.8% of the total patients had other tuberculosis patients in their family.

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A mass was noticed in the left internal malleolus of a ten-years-old boy in September 1995. Since then, tumors developed successively on the dorsum of the foot, on the tibial side of the popliteal fossa and in the upper region of the thigh. Biopsy of the malleolar tumor done at another hospital revealed a fibroma. In 1968, he was admitted to our hospital and en bloc excision of the entire tumors was performed. Histologically, each tumor showed virtually the identical appearance and consisted of irregularly interwoven collagen bundles with proliferated fibrocytes and fibroblasts infiltrating into the surrounding muscle fascicles. There were no cells with atypical, hyperchromatic or bizarre nuclei.
Mitosis was rare. It was thought to be desmoid tumors, but resorption of the bone graft in the metatarsal bone and mild cellurality in some sections of the specimen suggested more or less aggressive behavior.
Five years after surgery, the patient is well, but recurrence of the tumor has been found, in the inguinal region.
It seems quite unusual, that multiple desmoids developed one after another on the different levels of one extremity.

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Among abnormal patterns observed in the pulmonary perfusion scanning a linear fascicular decrease of radioactivity along interlobar fissure has been named fissure sign, which has generally been taken as a sign of embolism in that particular region. This pattern, however, can also be seen either in the lung with normal blood flow owing to extrapulmonary factors or in the case of pulmonary change other than embolism.
This paper deals with several cases presenting fissure sign treated by the authors and adds some discussion on this problem.
Case 1. A 35-years-old male had been hospitalized because of dyspnea. A scintigram revealed the left lung shrunken to a lump and cloverleaf-shaped right lung; that is, fissure sign and shrunken lobe were simultaneously observed in this case, which is especially characteristic of multiple pulmonary embolism.
Case 2. A 67-years-old male had the diagnosis of pulmonary fibrosis complicated by infection leading to pulmonary cerebropathy. X-ray examination of the chest showed severe fibrosis on both sides and infiltration in right upper and lower fields. A scintigram revealed fissure sign in left middle field and patchy hypoactivity in right upper field. There was no proof that fissure sign in this case was caused by embolism. In chronic diseases such as this case, fissure sign is complicated as it represents interstitial change and sequelae in addition.
Case 3. A female aged 56 had a diagnosis of hydrothorax. Fissure sign was found by profile scanning. Theoretically, it is natural that decrease in radioactivity in the part corresponding to the length of interlobar fissure is caused by hydrothorax. Furthermore, since peripheral resistance against pulmonary blood flow in increased in the cases of hydrothorax, it may also be possible enough that surrounding peripheral blood flow is diminished. As described above on fissure sign mainly in the cases treated by the authors, it may be said that diagnosis of pulmonary embolism is to be made without hesitation if shrunken lobe is found in association with fissure sign. The diagnostic problem becomes, therefore, apparent only when fissure sign is observed without being accompanied by segmental perfusion defect, especially without any corresponding findings in X-ray examination of the chest. Though peripheral hypoperfusion naturally exists in the above case, it will be necessary to investigate more cases at the present stage where much discussion remains with the range of supposition.

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The pseudohypertrophy on serratus anterior deltoid and calf muscle of 81 P. M. D. patients (Duchenne type) were observed. The results were as follows.
1) The pseudohypertrophy of serratus anterior was observed in 9 cases (11.1%), stage II to VI, and age 9 to 12.
2) That of deltoid was observed in 14 cases (17.4%), stage I to IV. Most of them were confined in wheelchair.
3) That of calf muscle was observed in 40 cases (nearly 50%). Especially for the ambulant patients, the incidence of the pseudohypertrophy in calf muscle reached to 84.6%.
4) No pseudohypertrophy was observed in stage VII and VIII.

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A forty-two-years-old house wife was admitted to the Sagamihara National Hospital in September, 1969 because of headache and dizziness. She had hypertension of ten years duration and marked hypopotassemia. Shortly after this admission she experienced episodes of cramps, unconsciousness and right hemiplegia.
She had the second stroke in July, 1970 and died three days later.
At autopsy a round tumor of two centimeters in diameter was found in the right adrenal gland. Histological examination revealed adreno-cortical adenoma of clear cell type consisting of mostly large and lipid-laden clear cell similar to those of zona fasticulata.
It was considered that this tumor might produce hyperaldosteronism and result in hypertension and cerebral hemorrhage ruptured into the ventricle.

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